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September 1, 2004

Improved Performance on the American Board of Surgery In-Training Examination: A Personal or Collective Effort?

Arch Surg. 2004;139(9):1025-1026. doi:10.1001/archsurg.139.9.1025-b

We read the article by de Virgilio et al1 with great interest. The authors concluded, after prospectively evaluating an educational intervention for a short period, that weekly reading assignments combined with weekly preparatory examinations significantly improved mean overall American Board of Surgery In-Training Examination (ABSITE) scores. The improved results are thought to be secondary to the educational intervention, even though the actual scores on the closed-book multiple-choice examinations did not correlate with the ABSITE scores. What is also interesting is that the scores on the muliple-choice examinations were not included in the overall resident evaluation process and that the exact amount of reading performed by each resident was not quantified. The ideal educational intervention is still debatable. Conference attendance2 does not significantly affect ABSITE performance, and results seem to be proportional to reading effort.3 This cannot be reliably tracked, and the same question persists throughout an individual's lifetime of education: can the collective effort replace personal motivation? Most students of knowledge will face the stress of proof, whether a midterm examination or a board recertification. The threat of failure drives effort, and it will be useful to see whether ABSITE results improve if scores are included in the resident evaluation process. This may become necessary as an additional proof of knowledge to be used by residency programs because ABSITE scores alone may not accurately measure competency, and they depend on several variables.4 In addition, would the same results be expected if online open- or closed-book examinations were adopted, and can the honor code guarantee personal reading effort?